高压氧治疗带状疱疹后遗神经痛的研究进展

带状疱疹后遗神经痛（ PHN）是带状疱疹最常见的并发症,以慢性顽固性疼痛为特征,其发病机制尚未明确,临床上治疗方法较多,但许多患者的疼痛仍未得到充分缓解,或者不能耐受药物的不良反应。高压氧治疗是近年来临床治疗中的一种较新的疗法,具有独特的疗效和优势,该文就近年来高压氧治疗PHN的研究现状及PHN的发病机制进行综述。     

中老年带状疱疹患者并发神经痛危险因素

带状疱疹后遗神经痛(postherpetic neuralgia,PHN)是带状疱疹(herpes zoster,HZ)最常见并发症,主要临床表现为闪电样、刀割样或烧灼样痛,且疼痛呈一过性或持续性,程度轻重不一,严重影响患者生活质量〔1～3〕。10%的HZ患者可并发PHN,60岁以上老年患者发病率更高〔4〕。目前仍有一半左右PHN患     

综合护理模式对老年中、重度带状疱疹后神经痛病人疼痛及抑郁焦虑的影响

正带状疱疹是由水痘-带状疱疹病毒引起的,除皮肤损害外,病毒侵犯神经可引起神经炎性浸润、沃勒变性、出血性坏死及神经脱髓鞘改变,导致神经痛发生。带状疱疹在人群中的发生率约为20%～30%,并随年龄的增长而增加,大于85岁的老年人发病率为50%左右。皮损愈合后,神经痛可能持续存在,形成后遗神经痛(postherpetic neuralgia,PHN),高龄及细胞免疫受损是PHN最主要的危险因素~([1])。除了以疼痛为主要表现外,PHN病人伴有严重的抑郁和焦虑情绪,严重影响病人的生活质量~([2-3])。目前PHN的临床治疗主要为抗病毒药物、镇痛药物及微创介入治疗~([4])。国内已有     

带状疱疹后遗神经痛治疗研究进展

正1引言带状疱疹(herpeszoster,HZ)是由潜伏的水痘-带状疱疹病毒(varicella-zoster virus,VZV)再激活引起的,多发生于免疫力低下人群,尤其是老年人。VZV初次感染人体后临床上表现为水痘或呈隐匿性感染,并潜伏于脊髓背根神经节、颅脑感觉神经节或肠道神经元。大约25%的病人出现HZ相关并发症,其中最常见的是带状疱疹后遗神经痛(post-herpetic neuralgia,PHN)~([1]),我国定义为HZ皮损愈合后持续至少1个月的疼痛~([2]),但国际上最常用的定义即HZ皮疹出现后持续至少3个月的疼痛~([3])。PHN的发病机制目前尚不明确,神经可塑性是其产生的基础,其机制可能包括:外周敏化、中枢敏化、炎性反应、传入阻滞、交感神经功能异常等~([4])。PHN在许多老年人中表现为单侧皮肤神经痛,通常涉及一种或多种类型的疼痛:自发性疼痛、烧灼样疼痛、刀割样疼痛、异常性疼痛和痛觉过敏。受累部位的疼痛可能持续数月或数年并严重降低病人的生活质量。     

小剂量糖皮质激素预防老年人带状疱疹后遗神经痛的临床观察

带状疱疹是由水痘一带状疱疹病毒引起的一种常见的病毒性皮肤病，因病毒侵犯神经和机体免疫反应，带状疱疹治愈后，易遗留疱疹后神经痛(Postherpetic neuralgia，PHN)，尤其是老年人，带状疱疹的发病率和PHN发生率均较高。PHN往往疼痛难忍，持续时间长，目前对PHN的治疗效果尚不满意，给老年患者造成极大痛苦，因而在带状疱疹治疗上，预防PHN发生十分重要。我们于2002年1月至2003年12月对69例老年带状疱疹患者进行了常规治疗和加用小剂量地塞米松治疗，以评价小剂量糖皮质激素预防PHN的作用。     

带状疱疹后神经痛诊疗新进展

艾滋病患者、肿瘤患者、接受器官移植者及老年人是带状疱疹高危人群。带状疱疹后神经痛(postherpetic neuralgia,PHN)为带状疱疹的后遗症之一,严重影响患者的工作、学习、生活和娱乐等日常活动,导致患者焦虑、抑郁,甚至自杀。该文就PHN近年来的诊疗研究进展进行综述。     

自拟中药疱疹止痛灵治疗中老年带状疱疹后遗神经痛的临床疗效

<正>带状疱疹为皮肤科与神经内科及中医科常见病、多发病,带状疱疹消退后常后遗顽固性神经痛,中医学称此病为"蜘蛛疮","缠腰火丹","串腰龙"等,但带状疱疹后遗神经痛(PHN)的中医药治疗临床及实验研究的报道较少。本文应用中药自拟疱疹止痛灵(HNK)治疗PHN,对其治疗效果进行临床评价。1材料与方法1.1临床资料全部病例均是经本院皮肤科或神经内科确诊的PHN的门诊患者。随机分为两组,治疗组115例,男47例,     

带状疱疹后神经痛的治疗

带状疱疹后神经痛(PHN)是指带状疱疹皮损消退后,受累区皮肤疼痛持续3个月以上,因其发生率高(9%～13%带状疱疹患者可出现带状疱疹后神经痛、60岁以上老龄患者带状疱疹后神经痛发病率可高达50%～75%[1])、持续时间长(可达3.5年).迄今仍有50%的带状疱疹后神经痛患者未得到合理、有效的治疗[2],所以其治疗尤为重要,现综述如下.     

局部激光照射治疗带状疱疹后遗肋间神经痛15例

带状疱疹后遗神经痛（PHN）是指带状疱疹皮损消退后,受累区皮肤疼痛持续3个月以上。2008年5月-2009年11月,我们采用半导体激光治疗仪行局部激光照射治疗带状疱疹后遗肋间神经痛15例,效果较好。现报告如下。     

壮医莲花针拔罐逐瘀法治疗带状疱疹后遗神经痛的护理

带状疱疹后遗神经痛（PHN）是带状疱疹（HZ）最常见的并发症。2009年3月～2010年3月,我们应用莲花针拔罐逐瘀疗法加上中草药湿热敷及适当护理治疗PHN,取得了较好的效果。现报告如下。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.